Bottom Line:
It is more common in diabetic and female patients, and can be associated with more serious complications, including pyelonephritis.The patient history ruled out trauma and CT scanning ruled out a fistula; culture of the urine then showed a bacterial load greater than 100,000 E. coli/mL.We present this case to increase health care providers' awareness of recurrent EC with a urine culture bacterial load greater than 100,000 E. coli/mL.

Context: Emphysematous cystitis (EC) is a rare infection of the urinary tract that results in gas production in the bladder. It is more common in diabetic and female patients, and can be associated with more serious complications, including pyelonephritis.

Case report: We describe a case of recurrent bacterial cystitis caused by Escherichia coli (E. coli). An incidental finding in our patient of pneumaturia on computed tomography (CT) scan prompted further work-up. Differential diagnoses for pneumaturia include infection, trauma, and fistula, most commonly colovesicular. The patient history ruled out trauma and CT scanning ruled out a fistula; culture of the urine then showed a bacterial load greater than 100,000 E. coli/mL. The patient was then diagnosed with EC. She was treated with ceftriaxone and released in stable condition.

Conclusion: The literature was scarce when it came to diagnoses of EC based on bacterial load. We present this case to increase health care providers' awareness of recurrent EC with a urine culture bacterial load greater than 100,000 E. coli/mL.

Figure 1: Incidental finding on the CT of pneumaturia, suggestive of EC

Mentions:
A 67-year-old woman presented to the emergency department with right hip pain secondary to a fall. The patient's vitals on presentation were as follows: Blood pressure (BP) 152/93 mmHg, heart rate (HR) 88 bpm, respiratory rate (RR) 20 breaths/min, temp. 97.9°F, and O2 sat. 96% on room air (RA). The patient had a past medical history of chronic EC, diabetes mellitus (DM), peripheral neuropathy, arthritis, coronary artery disease, and asthma. The patient underwent a right lower extremity computed tomography (CT) without contrast and was found to have a subcapital fracture with mild dorsal angulation. An incidental finding on the CT was pneumaturia, which was probably due to a case of EC [Figure 1]. Because of the finding of pneumaturia, pelvic CTs with and without contrast were ordered to rule out a colovesicular fistula, and one midstream catch sample and one catheterized sample of urine were taken and cultured. The CT scans ruled out any fistulas, and both urine samples were found to contain greater than 100,000 E. coli/mL. The patient was then treated with ceftriaxone 1,000 mg for 5 days, and was released in stable medical condition. On further examination of the patient's other medical records, three prior hospital admissions with the E. coli cystitis were noted, each with approximately the same bacterial load.

Figure 1: Incidental finding on the CT of pneumaturia, suggestive of EC

Mentions:
A 67-year-old woman presented to the emergency department with right hip pain secondary to a fall. The patient's vitals on presentation were as follows: Blood pressure (BP) 152/93 mmHg, heart rate (HR) 88 bpm, respiratory rate (RR) 20 breaths/min, temp. 97.9°F, and O2 sat. 96% on room air (RA). The patient had a past medical history of chronic EC, diabetes mellitus (DM), peripheral neuropathy, arthritis, coronary artery disease, and asthma. The patient underwent a right lower extremity computed tomography (CT) without contrast and was found to have a subcapital fracture with mild dorsal angulation. An incidental finding on the CT was pneumaturia, which was probably due to a case of EC [Figure 1]. Because of the finding of pneumaturia, pelvic CTs with and without contrast were ordered to rule out a colovesicular fistula, and one midstream catch sample and one catheterized sample of urine were taken and cultured. The CT scans ruled out any fistulas, and both urine samples were found to contain greater than 100,000 E. coli/mL. The patient was then treated with ceftriaxone 1,000 mg for 5 days, and was released in stable medical condition. On further examination of the patient's other medical records, three prior hospital admissions with the E. coli cystitis were noted, each with approximately the same bacterial load.

Bottom Line:
It is more common in diabetic and female patients, and can be associated with more serious complications, including pyelonephritis.The patient history ruled out trauma and CT scanning ruled out a fistula; culture of the urine then showed a bacterial load greater than 100,000 E. coli/mL.We present this case to increase health care providers' awareness of recurrent EC with a urine culture bacterial load greater than 100,000 E. coli/mL.

Context: Emphysematous cystitis (EC) is a rare infection of the urinary tract that results in gas production in the bladder. It is more common in diabetic and female patients, and can be associated with more serious complications, including pyelonephritis.

Case report: We describe a case of recurrent bacterial cystitis caused by Escherichia coli (E. coli). An incidental finding in our patient of pneumaturia on computed tomography (CT) scan prompted further work-up. Differential diagnoses for pneumaturia include infection, trauma, and fistula, most commonly colovesicular. The patient history ruled out trauma and CT scanning ruled out a fistula; culture of the urine then showed a bacterial load greater than 100,000 E. coli/mL. The patient was then diagnosed with EC. She was treated with ceftriaxone and released in stable condition.

Conclusion: The literature was scarce when it came to diagnoses of EC based on bacterial load. We present this case to increase health care providers' awareness of recurrent EC with a urine culture bacterial load greater than 100,000 E. coli/mL.